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SHOOK, HARDY& BACON REPORT ON RECENT ETS AND IAQ DEVELOPMENTS - November 5, 1993 ~ ~ ~.. ~ ~ ~ ~ IL SHB ~

REPORT ON RECENT ETS AND LAQ DEVELOPMENTS - IN THIS ISSUE - IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS • "Smoke-Free Environment Act of 1993" is introduced in the House, p 1. • Senator Mitchell's IAQAct of 1:993 passes the Senate, p. 1 • Maryland OSHA plans to issue emergency workplace smoking ban, p. 2. • Lawsuit is filed in North Carolina seeking overturn of public smoking bans p. 6. • Snringent public smoking,ordinance ad- vances in San~ Francisco, p. 6. IAQ in today's Report • Flight attendant submits written statement on airplane IAQ to Congress, p. 3. • Health off cials say flight attendant infected 23' others with tuberculosis during flight, p. 5. • Article entitled "Cabin Fevers," discusses the spread of infectious disease on airplanes, p. 12 ETS-RELATED LITIGATION AGAINST CIGARETTE MANUFACTURERS • Parties in child custody case appear on national talk shows, p. 10. ISSUE 59 LEGAL ISSUES AND DEVELOPMENTS • American Public Hcalth Association's annual meeting highlights ETS issues, p. 11. OTHER DEVELOPMENTSIMEDIA COVERAGE • Glantz releases new study on economic consequences of smoking bans on: restau- rants, p. 11. • U! S. Navy announces new smoking policy, p: 12. SCIENTIFIC/TECHNICAL ITEMS • "Previous Cancer and Radio erapy as Risk Factors for Lung Cancer in Lifetime Non- smokers," p. 13. • "Complex Mixtures of Tobacco smoke and! the Occupational Environment," p. 13. • "Nicotine Exposure and the Risk of SIDS," p. 13. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS • NSW'health minister launches advertising campaign in Australia, p. 14. • Australian ad'seeks individuals who allpgedly suffer from ETS exposure, p. 14. • Hungarian smoking ban legislation fails passage, p. 14. • Alleged effects of ETS on children by parents to be studied in the United King- dom, p. 14. • Prisoner case in Oregon is filed and dis- missed, p. 7. • Activity in Bluitr, Broin„ Butlrr, Dunn and LEGAL ISSUES AND DEVELOPMENTS •"The Effect of Implementation~ of Non- smoking Policies in~the Workplace: An tJ ~ Voth, p. 7. Update on the Law," p. 14. ~ ETS/M1Q LITIGATION'. NbT INVOLVING OTHER DEVELOPMENTS/MEDIA COVERAGE ~ CIGARETTE MANUFACTURERS • French are surveyed on attitudes about ETS, .~ ro a eal is decided 9 na • Pechan v D p. 15. , p. .. p pp . y • Bahura trial put on hold until November 8, • U.K. article entitled "Bang Goes That ~ ~ p. 9: Freedom," p. 15. ~ Three items relate to airplane

-- TABLE OF CONTENTS - Issue 59 November 5, 1993 IN THE UNITED STATES REGULATORY AND LEGISLATIVE MATTERS 10'3D CONGRESS [T] Waxman Proposes to Restrict Smoking In All Nonresidential Buildings ................................. 1 [2] [3] Mitchell IAQ Bill Passes in Senate ........................................................................................... 1 Hearing Held on Kennedy UAQAct ........................................................................................ 2 U'.S. OCCUPATIONAL SAFETY AND HFALTH. ADMINISTRATION (OSHiA). [4] Maryland OSHA Wants to Issue Emergcncy Temporary Standard to Ban [5] Smoking in the Workplace .................................................................................................... .. 2 ASH Demands Immediate Response to Emergency Standard Petition .......................... [6] Witness Statement on OSHA Reform Reveals Government Indifference _ [7] to IAQ Problems on Aircraft ................................................................................................... 3 Senate Republicans Ask Nominee to Answer Questions .......................................................... 3 [8] OSHA to Conduct Studies on Workplace Exposure to ETS ................................................... 4 [9]1 OSHA Reform Legislation Likely to be Reported ouoof Committee ....................................... 4 U.S. ES.TVIRONMENTAL PROTECTION AGENCY (EPA). ['1i0] ETSRiskAssessmnntLitigarion:,Plaintiffs File Sur-reply in Opposition to EPA's Motion to Dismiss Complaint .................................................•---...................--............ 4'. [!1'1] Administration and Congress Reach Accord on EPA Cabinet Status Legislation ..................... 5 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (H.I-"IS)~ [12] HHS Committee Places ETS on Meeting Agenda ...............................................................•-••S [13] Health Ofl:icialfr Say Flight Attendant Infected Coworkers with TB' ........................................ 5 WHITE HOUSE [14] Clinton Proposes Cigarette Tax to Nearly $1 Per Pack .................................................•.-••••--•• 6 STATE AND~LOCAL GOVERNM~ENTS[15] Mana i Foodt, Inn., et alr v. Wade, et al. (General Court of Justice, Superior Court Division„Guilford County, Nonh Carolina) (filed October 29, 1993) ................................... 6 [16] ETS-Rclatcd State and Local Legislation ................................................................................. 6 ETS-RELATED LITIGATIONAGAINST CIGARETTE MANUFACTURERS (17] Bcnt•z:- New Pro Se Prisoner Case in Oregon Dismssed' ........................................................... 7 [18]I Bluirr: Defendants' Responses to the Complaint Filcd ............................................................. 7 [19]! Broin: Depositions ofAdditional Senior Executives to be Taken ............................................. 8 [20] Butler: Defendants File a Motion for Summary Judgmenn ....................................................... 8 [2i] Dunn: Reply Briefs in Support of Defendants' Motions Filed ................................................. 8 [22] Voth: Defendants' Motions Sched'uled'forSubmission; PlaintifiFilcs Purported Third Amended Complaint .................................................................................... 9, ETS/IAQ LITIGATION NOT INVOLVING CIGARETTE MANUFACTURERS WORKPLACE: CLEAN IN.DOOR.A1R ACT [23] Pechan v. Dynapro: Inc., 1993 111. App. LEXIS 1598' (Appellate Court, Second'District, Illinois) (decided October 19; 1993) .................................••••-•.••-•---.•-•••.--..---9 WORKPLrCE: IAQ [z41 Bchura v.,SEW7nvesrors (Superior Court, District of Columbia) (filcd:Scptember 14', 1990) ....... 9 CHILD CUSTODY~ [25J Masone v. Tannrr(Superior Court, Sacramento, California) (Temporary custody order entered October 13, 1993)'.........-•-••.•••••-•.-••.••--.••-••••••••-••••••-.•••••• 10 GRADUATE SCHOOL EXPOSURE [26] Beckman v. New York City School of VisualArts (U.S. District Court, New York) (filed January 1!6. 1992) .............................................................................................. .......... 10 PRISONER CASE [27] Graham v: Guntsr, 1993 WL432565 (U.S. CourrofAppeals, Tcnth Circuit) (decided October 27, 1993)'(unpublished opinion) .............................................................. 10

Contents Continued, Issue 59 LEGAL ISSUES AND DEVELOPMENTS [28] "'You've Come a Long Way, Smokers'c North Carolina Preserves the Employee's Right to Smoke Off the Job in General Statutes Section 95-28.2," L.L. Fryc, North Carolina LatuReview„September 1993 ........................... 10 ..................................... 1l1 [29] i New York Attorney Advises Employers to Ban Smoking .................. [30]I Health Association Considers ETS Issues at Annual Meeting ................. ...........•--•••-••• 1'1. OTHER DEVELOPMENTS [31J New Glantz Study Reports No Loss of Business to Smoke-ftee Restaurants .......................... 1 1 [32] U.S. Navy Announces Uniform Smoking Restrictions .......................................................... 12 MEDIA COVERAGE [33] "Cabin Fevers," A. Landi, Frtquent Flyer, Nbvembcr 1993 .................................................... 12 [341 "Curing 'Sick Building Syndrome,'" G. Krieger, R. Grecnway _ and S. Sodcrsten, Elements, 1993 ............. ..... ......................................................................... ....... 12 SCIENTIFIC/TECHNICAL ITEMS UPCOMING SCIENTIFIC MEETINGS [35] Bugst Mold & Rot I9: Control'of Humidiry for Hcalrh, Artifacts and Buildings, Alexandria, Virginia, November 16-17, 1993 ....................................................... 12 LUNG CANCER [36) "Previous Cancer and Radiotherapy as Risk Factors for Lung CanceninLifcrimc Nonsmokers," G.C:,Kabat, CancrrCaures and'Contro/4:,489-495, 1993 [See Appendix A] ...... 13 [37] "lhcidence of Cancer Among Male Waiters and Cooks: Two Norwegian Cohorts," K. Kjaerheim and A. Andersen, Cancer Causzs and Control4: 419-426, 1993 [See Appendix A] .................................................................................................... .............. 13 OTHER HEALTH ISSUES [38] "Complex Mixtures of Tobacco Smoke and the Occupational Environment," D.M, Aviado. In: Parry's Industrial Hygicne and Toxicology (Fourth Edition, Volume 2, Part A). G.D. Clayton and F.E. Clayton (eds.). John Wiley and Sons, 107-148; 1993 [See Appendix A] ................................................................................. 13 [39]' "Nieotine Exposure and the Risk of SIDS," JL Milerad and H. Sundell. Acta Paediarrica (Suppl.) 389: 70-72, 1993 [See Appendix A] ............................................... 13 ETS EXPOSURE AND MONITORING [40] "Relevance of Nicotine Content of Common Vegetables to the Identi6c.ation of Passive Tobacco Smokers," E.F. Domino, E. Hornbach, and T. Demana, Medical Science Rcsrarch 21: 571-572, 1993 [Sce Appendix A] .............................................. 13 INDOOR AIR QUALITY' [411 "Is It Time to Change the Terminology of Sick Building Syndrome?" B. Jarvholin, IndvorEn,vironmrnt 2: 186-188, 1993 [Sec Appendix A] .................................. 13 ['42] "New Approaches for the Determination of Ventilation Ratcs:. The Role of Sensory Perception," M.V. Jokl, G.B. Leslie, and L_S. Levy, lrtdoor Envrronrnenr2: 143-148, 1993 [See Appendix A] ...................................... 13 [431 "Status of ASHR?.E Stand'ard'62 - Vcntilation for Acceptable Indoor Air Quality," W.G. Tucker, Proceedings oflndaorAi. "93 3: 525-530, 1993 [See Appendix A] ................... 14. IN EURaPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AusTRALiA [44] New Advertising Campaign Launched by NSW Health Minister .......................................... 14 [45] Antismoking Group Places ETS Advertisement ................ ..................................................... 14 HuNGGw1tY [I46] Smoking Ban Proposal Fails to Pass in Budapest ...................................................................,1'4, MALAYSIA [47] More Public Areas to be Designated Nonsmoking .......................................................•-••.•••• 14 UNITED K7NGDOM [48J Ofl'iceofPopulation and Censuses to lnvestigate Parental Smoking ...................................... 14

Contents Continued,, Issue 59 LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM [49] "The Effect of Implementation of Non-smoking Policies in the Workplace: An Update on the Law," L. Goldman,,.lddicrion, 11993 ......................................................... 114 OTHER DEVELOPMENTS FRANCE [50] 1 Surveys Report French Attitudes About ETS ................................••..-••••-••••••••-•••--••-••••••••--•• •- 15 UNITED ]KINGDOM [51]' Smokers Fired~ for Smoking on Factory Roof ......................................................................... 15 MEDIA COVERAGE UNITED KINGDOM [52] "Bang Goes That Freedom," B. Levin, The Timrs, October 11% 1993...........•..•--••-••••••--•••.•••• 15 APPENDIX A .................................................................................................... .............•---..........---- Article Summaries APPENDIX B .................................................................................................... ............. Upcoming Scientific Meetings

NOVEMBER 5, 1993. i REPORT ON RECENT ETS AND IAQ DEVELOPMENTS IN THE UNITED, STATES REGULATORY AND LEGISLATIVE MATTERS 103D CONGRESS [1] Waxman Proposes to Restrict Smoking In All Nonresidential Buildings On November 3, 1993, Representative Henry Waxman (D-Cal.) ~ introduced the "Smoke-Free Environment Act of 1993" (H.R. 3434). The bill would restrict smoking to separately ventilated~ areas of nearly every building in the United' States. The mea- sure woul& prohibit smoking indoors and in the immediate vicinity of the entrances to nonresidential buildings into which at least 10 people enter one day each week. The only exception to the prohibition would be specially designated areas that are "ventilated in accordance with specifications promulgated by the [EPA] IAdministrator that insure that air from the area is directly exhausted to the outside and does not recirculate or drift to other areas within the public facility," and intowhich "nonsmoking,individuals" do not have to enter for any purpose. Fines of $5,000 per day for viol'ations of the bill could be assessed against building proprietors, and action to enforce the bill could be taken by "any aggrieved person, any State or local government agency, or the [EPA] Administrator." A fact sheet accompanying the measure as released by Waxman recites assertions about ETS made by the EPA. In addition, in a letter to his congressional colleagues, Waxman cites the EPA Risk Assessment on ETS to support his legislation and attacks the tobacco industry for trying to create a "`wisp of uncertainty' about the health effects of tobacco even when overwhelming,scientific certainty exists." Waxman's bill is cosponsored by 35 other representatives. Senator Frank Lautenberg (D-NJ.) announced on October 29, 1993, that he planned to introduce companion legislation in the Senate. As of this writing,, that legislation had not yet been introduced: ' Lautenberg and Waxman appeared at a press confer- ence to announce the legislation. They were joined b members of BOMA and health and consumer organi- zations who spoke in favor of the bill. See PR Newswi're and Associated Press; October 29, 1993; BNA Daily La6or Report, November 1, 1993. [2] Mitchell IAQ Bill Passes in Senate On October 29, 1993, the Senate passed the Indoor Air Quality Act of 1993 (S. 656), which~was intro- duced in March by Maine Senator George Mitchell (D). The bill gives regulatory authority over indoor air to the EPA and provides for research to be conducted on indoor air quality issues. Similar measures were introduced and passed in, the Senate in the 101 st and T 02d Congress. Further details about the measure appear in issue 44 of this Report, April 2, 1993. The measure does not refer specifically to ETS, but the Senate report accompanying the measure specifically discusses the EPA Risk Assessment on ETS to supportt the claim that significant health effects result from contaminants in indoor air. Amendments made to the bilL in committee extend to 18 months from the date of enactment the time for EPA to publish a list of contaminants "that may occur or are known to occur in indoor air at levels which may reasonably be expected to have an adverse impact on human healthL" This list must contain "at a minimum, benzene, biol'ogicalicontaminants, carbon monoxide, formaidehyde, lead, methylrne chloride, nitrogen oxide, particulate matter, asbestos, polycyclic aromatic hydrocarbons (PAHs), and radon." The amendments also give EPA additional time in which to develop its first set of health advisories as well as give EPA additional research authority. Deleted from the measure are provisions for a new office of indoor air, qquality at EPA separate from the Office of Radiation and Ind'oor Air Quality, as well as 2 require-

2 ment for the Council on Indoor Air Quality to report to Congress on the progress of IAQ programs. During debate on the measure prior to its passage in the Senate, only one senator referred to the findings of the ETS risk assessment. Senator Joseph Lieberman (D-Conn.) stated, "Exposure to tobacco smoke is in fact responsible, according to EPA for 3,000 lung cancer deaths in nonsmoking adults and impairs the respiratory health of hundreds of thousands of chil- drem" The bill now goes to the House for consider- ation. See Associated Prfss;, October 29, 1993; Chicago Tribune, October 31, 1993. Senator Frank Lautenberg (D-NIJ.) supplemented the record on~ November 11, 1993, with his remarks in support of the Mitchell billl In this regard, he cited the ETS risk assessment, stating "earlier this year, EPA issued a scientifically peer-reviewed! report concluding that environmental tobacco smoke is a careinogen.°'He also referred to the PRO-KIDS (S. 2611) and PRO- FEDS (S. 262) legislation, he introduced this year, and he urged Congress to enact these bills as well. [3] Hearing Held on Kennedy IAQAct On November 1, 1993, a hearing was held before a House subcommittee on the Indoor Air Act of 1993 (H'.R 2919)~ introduced on August 6, 1993, by Massachusetts Representative Joseph Kennedy II1 (D). Representative Henry Waxman (D-Cal.) made a statemenr: during the hearing,in which he made a veiled reference to the legislation on ETS that he introduced~ to Congress two days later. Robert Sussman, deputy administrator of EPA, gave qualified support to the Kennedy legislation. He was concerned with the short time lines specified' for EPA action in the bill and indicated that requiring mandatory guidelines is premature until EPA has an opportunity to evaluate the success of voluntary programs. With regard to ETS, Sussman stated that it, and other; contaminants, "can cause long and short term health eff'ects, especially when inadequate ventilation allows ind'oor concentrations to increase." Sussman made a passing reference to the f ndings of the EPA Risk Assessment on ETS in his written statement to the subcommittee. ETS/IAQ REPORT, ISSUE 59 Lynn Rhinehart, testifying on behalf of the AFL-CIO, stated, "We strongly support the legislation's recognition that indoor air quality can be addressed through a building systems approach, and! that a contaminant-by-contaminant approach is not necessarily the only or even the best way to approach indoor air quality problems." Rhinehart suggested that the roles of NIOSH and OSHA be expanded und'er the legislation and urged Congress to "make clear that OSHA retains jurisdiction over indoor air quality in workplaces that fall' under OSHA's jurisdiction."' A BOMA representative referred' to the ETS risk assess- ment to support an assertion that ETS is "one of the most obvious and widespread sources of indoor air complaints." BOMA criticized the legislation, however, for taking a "polllstant-by-pollutant" approach: The organization ~ has also taken the position that EPA should non be given unilateral authority to regulate indoor air. An approach stressing practical guidance based on sound researchwould be preferred by BOMA Representatives from the Business Council on Indoor Air, Chemical'~ Specialty Manufacturers Association, National''Association of Manufacturers and Total Indoor Environmental QualicyCoalition also testified and were critical of the bill. Specifically cited was the additional layers of bureaucracy that would be created by the legislation, These organizations favor a building systems approach to 1AQ problems and strenuously objected to the role given to EPA under the bill. The hearing was before the H'ealth and~ Environment subcommittee of the House Committee on Energy and Commerce. U.S. OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA). [4] Maryland OSHA Wants to Issue Emergency Temporary Standard to Ban Smoking in the Workplace According to a press report, the Maryland Occupational Safety and Health Agency will'attcmpt to promulgate an emergency temporary standard to ban smoking in virtually every workplace in the state. The agency has apparently been directed~ by Maryland's secretary of licensing and regulation to draft a blanket emergency regulation prohibiting smoking, with no allowance for separately ventilated smoking areas, by the first week of November 1'993.

NOVEMBER 5, 1993 The proposal will reportedly be submitted to the governor and to the state's executive committee, which reviews state job safety rulemakings. The committee will decide whether to hold public hearings on the issue. A government spokesperson cited the EPA Risk Assessment on ETS as a motivating factor in the agency's decision and acknowledged that the rulemaking will probably be challenged in court. See BNA Daily Labor Report; November I, 1993. [5] ASH Demands Immediate Response to Emer- genry Standard Petition In a letter dated September 30, 1993, ASH demanded that OSHA "immediately take action~on ASH's petition for an emergency temporary standard" on~ETS. The letter continues, "Uhless a decision is made on our petition~ within ten days from the date of this letter, ASH will' feel free to file suit to have the U!S: Circuit Court here in Washingtons D.C. order OSHA to take action on the petition." ASH filed its petition for an emergency temporary standard with OSHA onJuly 12, 1993. Further details about that petition appear in issue 53 of this Report, August 6, 1993. As of November 4, 1993; there was no indication ASH had indeed filed a suit to force OSHA to act on its petition for an emergency temporary standard. Attached to ASH's letter are copies of its emergency petition, the January 1993 memorandum from outgoing Secretary of Labor Lynn Martin to Dorothy Strunk ordering OSHA to commence ETS rulemaking as soon as possible, and EPA and NIOSH' workplace smoking guidelines. In addition to the July 1993 Petition for Emergency Temporary Standard, three of the petitions ASH has filed directly with OSHA are currently pending. Also pending is a petition for review filed by ASU against OSHA in~ the District of Columbia Circuit Court of Appeals. In addition, ASH recently invited its support- ers to file ETS exposure complaints with OSHA. See issue 58 of this Report, October 22, 1993. [6] Witness Statement on OSHA Reform Reveals Government Indifference to IAQ Problems on Aircraft Flight attendant Deanne Clarke, who recently testified about OSHA reform legislation before the Senate Subcommittee on Labor, submitted a statement 3 to the subcommittee investigating IAQ problems on aircraft. In this regard, Clarke made the following remarks: • "There were 235 separate flights with air quality incidents and 506 related flight attendant illnesses reported from July 1989 to the present on my carrier alone. These flight attendants have reported headaches, blurred vision, an&other health prob- lems. The Association of Flight Attendants con- tacted the FAA immediately when flight attendants began getting ill. Despite numerous calls and letters, the FAA has never taken any action: In fact, my unionn learned last week that in September of 1991, the FAA requested that the carrier no longer send reporrs on air quality incidents and illnesses to the agency." • "Since the FAA claimed total jurisdiction over airline crewmember health and safety in 1975, the FAA has failed to make any serious effort to address occupational safety and health issues outside the area of crash survivability. The threat of... radia- tion, passengers' viral illnesses,... noise and inadequate climate controls argues forcefully for strong agency oversight of occupational hazards on aircraft. Yet, the reality is that flight attendants are unprotected and desperately need OSHA coverage." Most of Clarke's statement was concerned with the injuries she suffered on a 45-minute flight due to a carbon monoxide leak. See issue 58 of this R'eport,. October 22, 1993. The Safe Cabin Air Quality Act of 1993 (H.R. 2986) was introduced on August 6, 1993. The bill would require the Federal'Aviation Administration to issue regulations to improve indoor air quality on~commer- cial aircraft. [7] Senate Republicans Ask Nominee to Answer Questions According to a press report, Republican, members of the Senate Labor and Human Resources Committee recently sent a series of questions related to occupa- tional safety and health to Joseph Dear, the Clinton administration's nominee for assistant secretary in charge of OSHA. An OSHA spokesperson reportedly said that Dear was expected to complete his responses during the week of October 25, 1993. A Democratic

4 source, who had not seen the Republican questions, reportedly said the questions probably do not signal a possible impediment to Dear's confirmation as there stillidoes not appear to be any strong opposition to the nomination in the business community. See Occupa- tional Sa. fety d' H'ealth Reporter, October 27, 1993. [I8] OSHA to Conduct Studies on Workplace Exposure to ETS OS1 iA has reportedly decided to conduct two studies to assess whether there is a link between ETS exposure in the workplace andl increased risks of lung cancer and heart disease. The studies, which have been contracted to outside consultants, are scheduled to be completed in February and September 1994. The consultants will not apparently be conducting new research for the studies. Maryland-based Meridian Research Inc. will' reportedly be required'to review already available research purportedly linking ETS to cardiovascular disease and research on lung cancer conducted since the EPA Risk Assessment on ETS was released. The study to be conducted by Louisiana-based! Clement International will evidently review existing research to determine whether data measuring levels of cotinine and nicotine in the bloodstream of those exposed to ETS can be used to estimate risks of lung cancer and heart disease. OSHA reportedly decided to include cardiovascular research in the scope of its review because it determined "substantial evidence exists in the literature to support the agency including cardiovascular disease in its analysis of health effects" of ETS "and perhaps its inclusion in a preliminary quantitative risk assessment." See BNA Daily Labor Report„October 19, 1993. [9] OSHA Reform Legislation Likely to be Re- ported out of Committee According to House staffers, the House Educatiom and Labor Committee is detersnined'to report the Comprehensive Safety and Health Reform Act (H.R. 1280) out of committee this year with or without input from the Clintom administration. Although a number of hearings have been held on the measure, OSHA has not yet taken a formal position on the bill. Labor and industry representatives do not apparently agree on many of the bill's provisions, but chief counsel' for the subcommittee on Labor Standards, Occupa- ETS/lAQ REPORT, ISSUE 59 tional Health~and Safety has been quoted as saying that consensus is possible. Key provisions of the bill,, introducedlby Representative William Ford (D-Mich.), would increase employer-employee participation in safety efforts,,force more prompt federal response to safery petitions and create stricter penalties for violations. See Occupational H'ealth &Safery Letter, October 6, 1993. U.S. ENVIRONMENTAL PROTECTION'AGENCY (EPA) [ 10] ETS Risk AssessmentLitigatiom Plaintiffs File Sur-reply in Opposition to EPA's Motion to Dismiss Complaint The tobacco industry plaintiffs filed a sur-reply in opposition to the EPA's motion to dismiss on Novem- ber 2, 1993. The sur,reply responds to the new arguments raised by EPA's reply brief im support of the motion to dismiss which was filed on October 20, 1993. Further details about the EPA's reply brief appear in issue 58 of this Report, October 22, 1993. Plaintiffs argue that the EPA's Risk and~ Exposure Assessment Guidelines create "substantive predicates" that limit the agency's discretion and give plaintiffs a due process interest. According to plaintiffs, the Guidelines are unequivocal that EPA must satisfy certain criteria before designating a substance a Group A carcinogen: The plaintiffs also note that the EPA admitted the mandatory character of the guidelines in~ its answer to the complaint. Plaintiffs also argue that their goodbvill is a protected property interest and'criticize the cases relied upon by the EPA in attempting to refute this daint. Finally, the sur-reply challenges EPA's repetitive claim that EPA's decision is not, subject to judicial review. Scheduled ~ briefing on the motion to dismiss is com- plete; the court has not yet entered an order on the oral argument requested by plaintiffs. EPA did not request oral argument. The court also has not ruled on either of the pending motions for leave to file amici briefs. Plaintiffs' complaint in this case seeks a declaration that EPA's decision to designate ETS a Group A carcinogen, together with the risk assessment on which the decision is based, is unauthorized, arbitrary and capricious, violates procedures required by law, and amounts to a denial of due process. Plaintiffs also seek

NOVEMBER 5, 1993 a permanent injunction requiring EPA to withdraw the Group A designation and the underlying risk assess- ment. Fluc-Cured Tobacco Cooperative Stabilization Corporation, rt aL v. EPA (U.S. District Court, Middle District, North Carolina) (filed June 22, 1993)' [Il1] Administration and Congress Reach Accord on EPA Cabinet Status Legislation According to a press repon, the Clinton administra- tion and key House members have drafted a compro- mise measure which clears the way for floor action on a bill to elevate EPA to cabinet levelistatus. One major provision that is noticeably absent, from the House draft is a controversial risk-assessment amendment that was placed in the Senate bill! by Louisiana Senator Bennett Johnston (D). Although the Senate has already approved such a bill, (S. 171), the House measure has not yet been formally introd'uced. Further, details about the Senate measure appear in issue 47 of this Report, May 14, 1993. The draft measure reportedly will not contain an administration proposal to eliminate the White House Council on Environmental Qualiry; or task-specific language that had been proposed by R'epresentative John Conyers (D-Mich.): The bill does, however, apparently contain provisions to improve the EPA's management of outside contracts. SecAir Water Pollutdon Report, October 11, 1993; Hazardous Waste News, October 1'9; 1993. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)~ [12] HHS Committee Places ETS on Meeting Agenda The ICD-9-CM Coordination and Maintenance Committee of HHS will hold a meeting on December 2, 1993, during which it is scheduled to consider the classification of, among,other matters, the purported "toxic effect of second-hand smoke." ICD-9-CM~ is a coding system that is used for the reporting of diag- noses and procedures performed on a patient by hospitals and doctors. The committee was formed in September 1985. It is a federal' interdepartmental committee charged, in part, 5 with the mission of maintaining and updating the ICD-9-CM. This work includes approving coding changes and developing errata, addenda and' other modifications to reflect newly developed procedures and technologies and newly identified diseases. The committee also promotes the use of federal and nonfederall educational! programs and other communi- cation techniques to standardize coding applications and upgrade the quality of the classification system. The committee encourages participation in its deliberations by health-relate& organizations which are invited to discuss proposed changes to the coding system during public meetings. Committee recommen- dations must be approved by the National Center for Health Statistics and the Health Care Financing Administration of HHS. [13] Health Officials Say Flight Attendant Infected Coworkers with TB According to federal health officials, a Continental Airlines flight attendant with active tuberculosis (TB) infected 23 crew members who workedwith her during several lengthy internationali flights to Europe and Mexico inAugust and October 1992. The flights took place on aircraft with a ventilation system alleg- edly providing 50 percent fresh air and 50 percent recirculatedai'r every three minutes. Two crew mem- bers had'tested negative for TB before the flight, and then tested positive after flying with her. The other infected flight attendants had not been tested prior too the flights. The Center for Prevention Services, a Centers for Disease Control and Prevention agency (CDC); has reportedly recently studied the incident. A number of passengers who were on flights with the flight attendant were also tested,,and although some had positive skin tests, the CDC could not conclusively say that the virus had been transmitted by the flight attendant. The director of air safety and health of the Association of Flight Attendants reportedly said, "TB' iss particularly a risk, given the increasing incidence in the population. Aircraft ventilation systems need: to be designed assuming that TB is present. We hope that the CDC will expand its investigation of transmission of communicable diseases on airlines." See The New York Times, October 21, 1993.

6 WHITE HOUSE [14] Clinton Proposes Cigarette Tax to Nearly $1 Per Pack The Clinton health care reform proposallcontains a provision that would increase the federal tax on a package of cigarettes by 75 cents, from 24 to 99 cents. Increased taxes on cigarette papers, cigarette tubes, smokeless tobacco, pipe tobacco and rolling tobacco have also been proposed. These proposal's have been viewed' by public health officials and advocates as beneficial to nonsmokers in that they are expected to result in a decrease in the use of tobacco products. See issue 57 of this Report, October 8, 1991 STATE AND LOCAL GOVERND.TENTS [I15j Mana's Foods, Inc., et at v. Wade, et a1 (General Court of Justice, Superior Court Division,. Guilford County, North Carolina) i(filed Octo- ber 29, 1993) Eleven plaintiffs representing a broad range of affected interests have filed a lawsuit in a North Carolina state court against individual members of the Guilford County Board of Health (Board), the county health director and! Guilford County, alleging that the Board exceeded its authority when~ it voted to "ban" smoking in restaurants and other public buildings. The suit seeks a declaration that the Board's "Smoke Control Rules", as modified by a subsequently enacted! resolution, which was to take effect in January 1995, are null and''void, and preliminary and permanent injunctions regarding enforcement of the Rules. No monetary damages are sought. The complaint alleges that in September and October 1993, the Board adopted rules and a resolution requiring,that all'eating establishments prohibit smoking after December 31, 1994, unless the owner or proprietor can demonstrate that the air in designated smoking areas is cleaned to the extent that it is equiva- lent to being "smoke-free." These provisions, according to plaintiffs, conflict with local smoking ordinances and will result in harm to the plaintiffs in the nature of lost sales, loss of convention business, and the inability to smoke in any restaurants in the county. ETS/IAQ REPORT, ISSUE 59 The plaintiffs claim that the 1Soard has exceeded its authority in adopting the Rules, that any state laww giving a local health~ board authority to regulate smoking is unconstitutional, and that the enactment of the Board's Rules violated due process. The plaintiffs are Mana's Foods, Inc., owner and' operator of a restaurant in Greensboro, North Caro- lina; the Greensboro-Guilford County Tourism Development Authority, a non-profit public authority which operates the Greensboro Area Convention and Visitors Bureau; Market Square Partnership, owner and' operator of several Guilford County buildings; the Shamrock Gravure Ptod'ucts Company, a Northi Carolina supplier of products used in theinanufacture of tobacco products; the Canteen Corporation, a Delaware corporation which operates the cafeteria for the Lorillard! production facility in Guilford County; Trudy Early and Steve Troxler,,counry residents and tobacco farmers; and Lorillard Tobacco Company, a Delaware corporation and tobacco products manufac- turer. Plaintiffs are represented by Womble Carlyle Sandridge & Rice. [161 ETS-Related State and Local Lcgislation •Local Governments in California LosAngeles: Media reports about the restaurant smok- ing ban that has been in effect since August 2„ 1993, indicate that business at some restaurants has declined by as much:as 50 percent. See KCAL Prime 9 News; October 15, 1993; The Los Angeles Business fourna4 September 20, 1993. San Francisco. On Nbvemlier 11, 1993, the Board of Supervisors unanimously approved a proposed smok- ing restriction, ordinance. The ordinance reportedly would prohibit smoking in all workplaces except bars, bar areas in restaurants, home offices, nonseating areas at Candlestick Park, bingo parlors, banquet halls, some hotel and motel rooms, and lobbies of hotels and motels. The prohibitions against restaurant smoking would take effect on January 1, 1995. The ordinance now goes to Mayor Frank Jordan. According to a news story, Jordan has indicated he supports the measure. See San Jose Mercury News, November 3, 1993; San Francisco Chronicle, November 2, 1993. San Jose. On October 26, 1993, the City Council unanimously directed' the city attorney to draft an

NOVEMBER 5, 1993 ordinance that would prohibit smoking in workplaces,, restaurants, and the common areas of apartment buildings and condominiums. The council may vote on the ordinance before the end of the year, according, to a newspaper anicle. See The San Francisco Chroniclr,. October 28,,1993. Santa Clara. Om November 9, 1993, the City Council is scheduled to hold a public hearing on a proposal to prohibit smoking in all public buildings, workplaces, restaurants and bars. At the conclusionof the hearing, the council plans to "consider" the proposal and other options, according to a newspaper article. See San Jose Mercury News, October 19, 1993'. West Hollywood According to a newspaper article, a group of restaurant owners has filed with the City a petition bearing the signatures of 1,000 persons who want the City Council to rescind a restaurant smoking ban that took effect October 6. At a council meeting, on October 25s some restaurant owners said they had lost business to neighboring cities and have had to lay off employees. Based on the information available at the time this report was prepared, the council had not yet voted on whether to rescind the ban. See Los Angeles Times, October 28, 1993. •Florid'a A House bill that would prohibit smoking in restau- rants was prefiled'on October 26, 1:993. See H.B. 185,. 13th Legislature, Second Regular Session (1994). •T.ocal Governments in Kansas Overland Park. On December 13, 1993, the 10- member City Council is scheduled to vote on an ordinance that would restrict smoking to separately- ventilated rooms in all public places except taverns that do not sell food. A councilI committee approved the ordinance on November 3 by a vote of 3-2. If the council approves the ordinance, Overland Park will! become the first city in the Kansas City metropolitan area to so restrict smoking. See The Kansas City Star, November 4, 1993. •Wisoonsin An Assembly B'ill that would prohibit smoking in shopping malls was introduced on October 26, 1993. SeeA.B. 881, 91st Legislative Session (1993-94). 7 ETS-RELATED LITIGATION AGAINST CI GARETTE MAN UFACTU RERS [17] Bentz: New Pro Se Prisoner Case in Oregon Dismissed On October 21, 1993, Judge Helen Frye sua sponte dismissed this action without prejudice. "Construing,the allegations in the complaint in their broadest light," Judge Frye wrote, "the court concludes that the allega- tions are not adequate to state a claim. While products liability law is constantly expanding, the court finds that the products liability statute will not support an injunc- tion against the defendants to refrain from marketing their tobacco products in the State of Oregon. The count funher finds that the products liability statute of the State of Oregon and the federal cigarette labeling and advertising requirements in 18 U.S:C. §§ 1331 et seq. do not support the claims for damages made by Bentz."' The order is reported at 1993 U!S. Dist. LEXIS 14928. American Tobacco, American Brands, Eagle Tobacco Corp. and Ultratech Corp. were the defendants in thiss case, which was filed in the U.& District Court for the District of Oregon. Plaintiff Travis Bentz, a prisoner cn an Oregon jail who filed the case pro se, alleged he had an unspecified irreparable injury and had incurred a "reasonable fear of contracting one or more of the known fatal'i effects" from being exposed to environmen- tal'tobacco smoke. He further alleged that cigarettes and other tobacco products are "unreasonably dangerous to consumers, bystanders,,and the general public." Bcnzz v: Eagle Tobacco Corp,, et al: (U.S District Court, Oregon). (f lhd September 27, 1993). [18]' Bluitt. Defendants' Responses to the Compiaint Filed On November 1, 1993, defendants filed two joint motions in response to plaintiff's' complaint. They filed a motion~to disrrtiss for improper~ venue or, in the alterna- tive, to transfer venue to the U.S. District Court for the Northern District of Texas. Defendants also filed a motion to dismiss due to plaintiffs' failure to plead their fraud, misrepresentation, concealment and conspiracy claims with. paniculariry. Plaintiffs in this action allege Willie Ruth~Bluitt was a nonsmoker who died of lung cancer as a result of her .~'. exposure to environmental tobacco smoke. Defendants in lr

8 the action are the six majpr U.S. cigarette martufacturers. Bluitt v. RJ.Rcynol'ds Tobacco Co., et aL (U.S. District Court, Eastern District, Texas) (filed August 30, 1!993). [19] Broin: Depositions ofAdd'itional Senior Execu- tives to be Taken Bennett Lebow of Liggett Group was scheduled to be deposed by plaintiffs on November 5, 1993. Plaintiffs also are scheduled to depose four representatives of The Tobacco Institute - Samuel Chilcote, Walker Merryman, Brennan Dawson and Thomas Lauria - on November 18-19. A deposition of a representative of the Council for Tobacco Research, Dr. Glenn, was postponed from November 4 and a new date has not been set. At issue in this case are the claims of 28 flight attendants allegedly injured by occupationalI exposure to ETS. In addition, the husband of one of the flight attendants claims lbss of consortium. The 28'attendants purporn to represent a class of approximately 60,000 other atten- dants. Plaintiffs' class action allegations have been dismissed by the trial court; plaintiffs' appeal of that dismissal lis pending in the Florida Court of Appeal. Injuries alleged by the putative class representatives include lung cancer, breast cancer and unspecified respiratory ailments. Plaintiffs further allege that occupa- tional exposure to ETS on, board aircraft causes at least 22 diseases and a reasonable fear of contracting such diseases. The defendants are purported to be the six major U.S, cigarette manufacturers (plus related entities)„UST; Inc., United States Tobacco Company, Dosal Tobacco Corp.,, the Council for Tobacco Research, The Tobacco Insti- tute, and three trade associations. Brain, et aL, v. Philip Morris, et a1(Circuit Courts Dade County, Florida) (filed October 31, 1991). [20] Butla: Defendants File a Motion for Summary Judgment On October 25, 1993, defendants filed a motion for partial summary judgment on plaintiffs' failure to warn and concealment claims based' on preemption. Defen- dants also sought summary judgment on plaintiffs' remaining claims (except for design defect) based on state law grounds. Defendants have noticed depositions of some of Burl Butler's customers and' friends for November 16-17. ETS/1AQ REPORT, ISSUE 59 Plaintiffs contend that Burl Butler, a barber from Laurel, Mississippi, developed lung cancer as a result of his exposure to environmental tobacco smoke. The defendants in this case consist of the six major U.S. cigarette manufacturers and several', local retailers. Butler v. Rf. Rrynolds Tobacco Company, et aL (Circuit Court, Hinds County, Mississippi) (filed October 21, 1992). [21] Dunn: Reply Briefs in Support of Defendants' Motions Filed Pursuant to the scheduling order entered by the court on August 12, 1993, defendants submitted reply briefs in support of their respective motions on October 25. The cigarette manufacturing defendants, The Tobacco Institute and the Council for Tobacco Research filed a reply brief in support of their joint motion to transfer venue from the Circuit Court of Delaware County, Indiana; to the Circuit Court of Grant County, Indiana. The holding company defendants - Ameri- can Brands, Loews Corp, and RJR Nabisco Holdings Corp. - fil'e& reply briefs in support of their separate motions to dismiss for lack of personal jurisdiction. The court is schedultd~ to hear argument on the motions on December 2. On October 26, plaintiffs fsled a motion for leave to add Brooke Group Ltd. as a defendant. Plaintiffs contend in the motion~that defendant Liggett Group "is a mere instrument" of Brooke Group "through which Brooke manufactures and distributes cigarettes and'that Liggett's total financial picture is subsumed into Brooke's fi- nances." In addition, plaintiffs contend that if they "sltould prevail they shouldibe entitled to execute their judgment against Brooke for the simple reason that Brooke and Liggett are ... one financial entity." Plaintiffs in this case contend'that Mildied Wiley was a nonsmoker who died of lung cancer as a result of work- place exposure to environmental tobacco smoke. Her husband, Philip Wiley, is also asserting a loss of consor- tiumclaim. Defendants'in the case are each of the six major U.S. cigarette manufacturers, parent companies of three of the manufacturers, The Tobacco Institute, and the Council for Tobacco Research, Dunn v. RJR Nabisco Noldings Corporation, etaL (Superior Court, Delaware 1993): County, Indiana) (filed May 28.

NOVEMBER 5,11993 [22] Yoth: Defendants' Motions Scheduled for Submission; Plaintiff Files Purported Third' Amended Complaint On October 15, 1993, Judge Robert Jones issued an order scheduling two of defendants' motions for submission on the court's February 22, 1994, "not, for oral argument" calendar: Brown & Williamson, Forsyth Tobacco Products and R.J. Reynolds' joint motion to strike plaintiff's motion for preliminary injunction, and Philip Morris Companies' motion to dismiss for lack of personali jurisdiction. In his motion for preliminary injunction, plaintiff seeks an order banning the sale of cigarettes in Oregon. On, October 22, plaintiff submitted several motions, including a motion for leave to f le a third amended complaint, which purports to substitute Philip Morris Incorporated! for Philip Morris Companies. He also submitted a motion for appointment of counsel (Mr. Voth filed'the case pro se) i In addition, he filed an objection to the motion to strike his motion for preliminary injunction and an amended motion for preliminary injunctive relief. In opposition to the motion to strike his motion for preliminary injunc- tion, plaintiff alleged that he is housed'. in an area of the prison in which smoking is allowed. Frank Voth, who is incarcerated in the Oregon State Penitentiary,,alleges that his civil rights have been~ violated as a result of his exposure to environmental tobacco smoke. He claims that he has "incurred permanent health damage and is at: risk of death~" as a result of being exposed to ETS. Defendants in l?oth are Forsyth Tobacco Products, R.J. Reynolds, Brown & Williamson, Philip Morris Companies and American Tobacco. Voth v. Forryth Tobacco Products, et at (U.S. District Court, Oregon) (filed April 27, 1993). ETS/IAQ LITIGATION NOT INVOL\!I'NG CIGARETTE MANUFACTURERS WORKPLACE: CLEAN INDOOR AIR ACT [23] Pechan v. I)ynapro, Inc., 1993 Ill. App. LEXI!S 1598 (Appellate Court, Second District, Illinois) (decided October 19, 1993) An appellate court has determined that a nonsmoking employee who claimed she had been injured by 9 exposure to ETS and discriminated against for complain- ing about ETS may pursue her discrimination claim against her former employer. In so ruling, the court affirmed the dismissal of the personal injury claims (battery and common law and statutory negligence) made by the plaintiff and determined that she could not seek an injunction to ban smoking at her former place of employ- ment. Further details about the case appear in issue 32 of this Report, October 6, 1992: The court found that the Illinois Clean Indoor Air Act (Act) ~ permits a private cause of action for damages in the event that someone is discriminated against because of the exercise of any right thereunder. Plain- tiff Pamela Pechan, the former office managerof Dynapro, Inc., alleged that her employer, in retaliation for her complaints andl legal action regarding the office smoking policy, discriminated~ against her by (i) removing property from her office without her con- sent, (ii) preventing her from performing her usual tasks, and (iii) assigning her to menial tasks. The court found that there was a genuine issue of material fact as to whether she had been reassigned to different tasks as a result of exercising her rights under the Act. In ruling on Pechan's battery charge, the court stated, "[w]e wish to clarify that we are not holding that one can never be battered by second-hand smoke. We hold' that the facts allcged in this case do not give rise to a battery." The courn also~ruled that the alleged injuries arose out of and in the course of employmenn and thus, that the Workers' Compensation Act provided the exclusive remedy for Pechan's negligence claims. Because Pechan1ad delayed seeking a jury trial, the court remanded the case to the trial court for decision. WORKPLt1CE: IAQ [24] Bahura v. SEW Investors (Superior Court, District of Columbia) (filed September 14, 1990) Trial commenced on October 25, 1993. Following jury selection and opening,statements, Superior Court Judge Rufus King, III, citing other court business, put the trial on hold until November 8, 1993. The triali is expected to last five or six weeks. The case involves employees who have sued various parties involved in renovating the EPA's headquarters

10 in Washington, D.C. Plaintiffs allege health problems due to poor indoor air, qquality. CHILD CUSTODY' [25]' Masone v. Tanner (Superior Court, Sacramento, California) (Temporary custody order entered October 13, 1993) During the week of October 25, 1993, the parties in this action appeared on the OPRAHtalk show as well as CNN's Sonya Live to discuss this ongoing custody suit. See issue 58 of this Report, October 22, 1993. Susan Tanner, the mother of the child, has said the court's temporary order awarding custody to the paternal grandmother did not specifically discuss smoking. Rather, she claims the child was removed by the court because she was being used as a"pawn°' in this "war between the parents." She also claims that childi abuse accusations have been levied! against her ex- husband, Steve Masone, and that he was previously allowed only visitation that was supervised. Tanner continues to claim she does not smoke in the home or car and that the custody issue involves far more than the issue of smoking. See CNN Sonya Live, October 26, 1993, and OPRAH, October 28, 1993. GRADUATE SCHOOL FaPOSURE [261 Beckman v. New York City School of Visual Arts (Ui.S. District Court, New York) (filed January 16, 1992)On October 15, 1993, following ten months of inactivity in this case, the court entered an order placing the case on the suspense docket. The case involves a daim~ by Melissa Beckman that she had to take a medical leave of absence from the graduate school because ETS exposure allegedly caused her to suffer "repeated blackouts, frequent vomiting, high fevers, infections, weight gain, mood swings and other physical and emotional, trauma." Beckman has re- quested $5 million in actual damages, $5 million in punitive damages, and an injunction to eliminate smoke in the school. ETS/IAQ REPORT, ISSUE 59 PRISONER CASE [27] Graham v. Gunter, 1993 WL 432565 (U.S. Court of Appeals, Tenth Circuit) (decided October 27, 1993) (unpublished' opinion)' The Tenth Circuit Court of Appeals has determined that a state prison inmate complaining of ETS expo- sure has sufficiently alleged personal participation of the defendants in violating his rights to remand the case for further proceedings. In his pro se complaint, Harold Graham alleged that he had breathing prob- lems and was being housed~ with a smoking inmate. He later amended the complaint to state that "Defen- dants have committed battery upon this peti>:ioner [by] exposing petitioner to toxic fumes and vapors," The appellate court concluded that this was an allegation that each and every named defendant "willfully forced'Mr. Graham to be exposed to envi- ronmental tobacco smoke." The court ordered the district court: to allow service on the defendants, LEGAL ISSUES AND DEVELOPMENTS [28] "`You've Come a Long Way, Smokers': North Carolina Preserves the Employee's Right to Smoke Off the Job in General Statutes Section 95-28.2," L.L. Frye, North Carolina Law Review, September 1993' This article discusses privacy legislation enacted in North Carolina, which protects from employment discrimination those employees wholaw-fully use lawful products during nonworking hours off the employer's premises. The author examines other similar legislation, sets forth~ the legislative history of the statute, and speculates about which provisions are likely to give rise to litigation owing to those few employers who may be inclined to discriminate against smokers to test the scope of the legislation. Concluding that the statute is a "well-balanced piece of legislation because it; preserves employee privacy and liberty to a reasonable degree„while permitting employ- ers to limirthose freedoms in situations where employee protection would be inequitable or impracticaL" the author acknowledges that her analysis rests on the premise that employers should not be free to fire or not hire someone for reasons unrelated to job performance.. 2024'7();~61 `1

NOVEMBER 5, 1993 [29] New York Attorney Advises Employers to Ban Smoking New York attorney Richard Corenthal has reportedly written an article appearing in a New York State Bar Association newsletter which advises employers to ad'opt and implement smoking bans in the workplace to avoid potential lawsuits and workers' compensation claims.. Evidently, Corenthal' discusses the EPA Risk Assessment on ETS an& predicts that it will result in an increase in the number of claims and' lawsuits filed by employees alleging ETS-related injuries or illnesses. The artide also reportedly considers OSHA activitywith regard to workplace smoking. Corenthal acknowledges that OSHA is having "great difficulry" in establishing,a thresh- old finding of significant risk to health or safety before promulgating standards andispeculates that an ETS rulemaking process will be quite lengthy. See Occupational Safety ut ' Health Reporter, October 27, 1991 [30] Health Association Considers ETS Issues at Annual Meeting The EPA Risk Assessment on ETS was highlighted during several presentations made at the American Public Health Association's annual meeting held Octo- ber 24-28, 1993. A representative of the EPA told those attending the meeting that although EPA has no regula- tory authority over ETS, the ETS risk assessment was undertaken because of a gap in control programs per- ceived! by the EPA. She described the policy implications of the ETS risk assessment in terms of a wave of smoking controll regulations„ an increase in state and local' government regulations, increased liability of building,owners and employers for alleged injuries to their employees from ETS, and an increase in voluntary smoking restrictions in private buildings. The EPA is apparently continuing to develop a smoking policy guide which is due to be released sometime in 1994. Kathleen Scheg of ASH discussed the ETS risk assess- ment during,her presentation and'suggested that it had important ramifications in eliminating smoking,from the workplace, increasing the incidence of smoke-free public places, bringing,smoking issues into child custody suits, and litigating discrimination claims against employers under the Americans with Disabilities Act. Scheg,also spoke of ASH's petitions and' lawsuit against OSHA and 11 informed meeting,participants that ASH is making partially completed OSHA complaint forms available to those wishing to complain about workplace smoking policies. Scheg also suggested that cigarette companies may be held liable under the civil RICO statute for inciting smokers to respond violently to nonsmokers who attempt to enforce their rights: Stanton Glantz, who was attending the meeting, stated that he was conduct- ing a study of smokers' rights literature with a linguist to determine whether the tobacco industry is purposely using language that is calculated to incite violent action by smokers. He alko noted that California:will be releasing a risk assessment this year that purports to be the world's first comprehensive risk assessment ad'dress- ing ETS and'all health endpoints. Literature available to meeting participants included a brochure published by the U.S. Department of Health and~ Human Services and the Centers for Disease Prevention and Control entitled "Secondhand Smoke, Environmental Tobacco Smoke, Passive Smoke, Call it What You Like - It's Poison." The document cites the ETS risk assessment and urges nonsmokers to insist upon a smoke-free environment. See BNA Daily I;abor Repon,,October 27, 1993. OTHER DEV'ELOPIv1ENTS. [31] New Glantz Study Reports No Loss of Business to Smoke-free Restaurants. A study of the economic consequences of smokingg bans in restaurants was released on October 28; 1993, during the annual meeting of the American Public Health Association. According to the study, restaurants in cities with nonsmoking ordinances arc not losing business to neighboring communities that do allow diners to smoke in restaurants. The study, sponsored by the University of California, San Francisco, and conducted by Stanton Glantz and Lisa: Smith, purportedly used quarterl}' sales tax data obtained from the California State Board of Equaliza- tion. Press reports indicate that besides 10 California cities, 3 in Colorado were also studied: The 13 cities aresaid to be the first in the country to ban smoking in restaurants. The study also reportedly looked at

12 restaurant business in 13 control cities which have no smoking restrictions. Press reports indicate that based'on the study resulis,. Glantz says he is advising legislators and government officials that they "can enact such health and'safery requirements to protect patrons and employees in restaurants from the toxins in secondhand tobacco smoke without the fear of adverse economic conse- quences." The study was apparently funded by the Cigarette and Tobacco Surtax Fund of California. See Business Wire, October 27, 1993. [32] U.S. Navy Announces Uniform Smoking Restrictions Uniform smoking,regulations inside ships, aircraft vehicles and buildings will take effect at all Navy and Marine Corps commands on January 1, 1994, accord- ing to media reports. Under the new regulations, commanders will be required to provide at least one smoking area on each ship, but generally speaking, smoking will be prohibited in all work and living areas. Currently, Navy smoking regulations are left to the discretion of the commanding officer of each ship. Some commanders had prohibited on-board smoking altogether. On the smoke-free aircraft carrier USS Theodore Roosevelt, there apparently have been reports of a black market in cigarettes and4 crewmen~ smoking in hiding places. A Navy spokesman denied that those reports are related to the new regulations. The Navy reportedly has set a goal to become smoke- free by the year 2000. See The San Diego Union- Tribune, October 28, 1993'; Chicago Tribune, October 24, 1993: MEDIA COVERAGE [33] "Cabin Fevers," A. Landi, Frequent Flyer, November 1993 This articl'e discusses the issue of the spread of infectious diseases aboard aircraft due to a decrease in the amount of fresh air circulated in airline cabins since the energy shortages of the 1970s. The author quotes industry representatives who claim that the air on airplanes is well-frltered and healthy, but she also ETS/IAQ Ri.PORT, ISSUE 59 observes that dirty air filters have been known to cause nausea and headaches in passengers, A Department of Transportation study conducted in 1989 reportedly found that declared bacteria levels in airline cabins are safe, although carbon dioxide builds up to more than four times typical ground-level concentrations. The article also addresses other aircraft IAQ problems, induding radiation exposure, low humidity and dehydration. The author concludes, "if you're sick, especiallywith a contagious illness, use common sense: For your own comfort and the sake of other passengers, don't fly until you~get betten°' [34] "Curing 'Sick Building Syndrome,'" G. Krieger,. R Greenway and S. Sodersten, Elements, 1993 This artide discusses probable causes of poor IAQ and makes common sense suggestions for investigating and ameliorating IAQcomplaints. The major focus of the article is ventilations but the authors also discuss source control and recommend banning smoking or designating smoking areas with separate ventilation systems. SCIENTIFIC/TECHNICAL ITEMS UPCOMING SCIENTIFIC MEETINGS [35]' Bugs, Mold & Rot II: Control of Humidity for Health, Artifacts and' Buildings,,Alexandria, Virginia, November 16-17, 1993 The Building Environment and Thermal Envelope Council, described' as "an~ organization commirted to promoting cooperation between the public and private sectors of the building community," is sponsoring,this two-day symposium on issues related~ to indoor humidity. In addition to covering such topics as control of microbiological contaminants, building design solutions„and effective ventilation, conference participants will "[f]ormulate new proposed indoor humidity control guidelines that enhance occupant health, building,life and energy conservation," accord- ing to the conference program, The conference also indudes a session called "Washington Update," for which Kevin Teichman (U.S. EPA), Charles Adkins (OSHA),,and Andrew Persily (National Institute of Standards and Technology) are scheduled speakers. C

NOVEMBER 5, 1993 LUNG CANCER [36]' "Previous Cancer and Radiotherapy as Risk Factors for Lung Cancer in Lifetime Nonsmok- ers," G.C. Kabat, Cancer Causes and'Control4: 489-495, 1993: [See Appendix A]'A case-control study of lung cancer M nonsmokers is the source of the data reported in this paper. The author indicates that "a detailed history of exposure to environmental tobacco smoke"'was taken for study participants, but does not present risk estimates for ETS exposure. The results for women reported in this paper suggest lung cancer risks in the range of 4.0 to 5.0 for a history of reproductive cancer and a history of radiotherapy; the author compares the magnitude of these risks to a summary risk reported elsewhere for ETS exposure of 1.341 [37] "Incidence of Cancer Among Male Waiters and Cooks: Two Norwegian Cohorts,"'K Kjaerheim and A. Andersen, Cancer Causes and Control4: 419-426, 1993 [See Appendix A]' The authors of this study report finding excess risk of "alcohol-related" cancers among cooks and waiters, and an excess of lung cancer among waiters. They attribute their findings to alcohol consumption ~ and tobacco smoking, but also invoke ETS exposure as a "possible explanation" of the reported difference in lung cancer risk, stating that waiters are more heavily exposed to ETS than are most other occupational groups. OTHER HEALTH ISSUES [38] "Complex Mixtures of Tobacco Smoke and the Occupational Environment," D,IVI.. Aviado. In: Patty s IndustrialHygiene and Toxicology (Fourth Edition, Volume 2, Part A) L G.D. Clayton and F.E. Clayton (eds.): John Wiley and Sons, 107-148, 1993 [See Appendix A] In this extensive review, the author examines the methods for developing workplace standards employed by several agencies, and reviews the available data on workplace ETS exposure and reports of chronic disease (lung and other cancers, respiratory tract diseases, and heart disease). He condudes that data on household ETS exposure and claimed associations between spousal smoking and disease cannot be extrapolated to the workplace. 13 [39] "Nicotine Exposure and the Risk of SIDS," J. Milerad and H. Sundell, Acta Paediatrica (Suppl.) 389:' 70-72, 1993 [See Appendix A] The authors of this paper review data and present new data on nicotine exposure in infants. They conclude thatt nicotine exposure and parental smoking,"link ... seemingly independent observations" about SIDS. ETS EXPOSURE AND MONITORING [40] "Relevance of Nicotine Content of Common Vegetables to the Identification of Passive Tobacco Smokers," E.F. Domino, E. Hornbach, and T. Demana, Medical Science Research 21: 571-572, 1993 [See Appendix A] The authors of this paper present results of their analyses of the nicotine content of several common food'~ items. They suggest that nicotine consumed in food can produce low levels of cotinine in body fluids, and could' affect the accuracy of a "background correction"' for ETS exposure, such~as was used in the EPA Risk Assessment on ETS. Ser Issue 54 of this Report for a letter to the editor by these authors on the same topic. INDOOR AIR QUALITY [41] "Is It Time to Change the Terminolo&v of Sick Building Syndromc?"' B. Jarvholm, Indoor Envi- ronment2: 186-188, 1993 [See Appendix A] In~ this opinion piece, the author suggests that the term "sick building syndrome" should be avoided when discussing health claims apparently related to occupancy of a building, noting that, as an endpoint, SBS is vaguelydeftned and of unknown etiology. [',42] "New Approaches for the Determination of Ventilation Rates: The Role of Sensory Percep- tion," M.V. Jokl, G.B. Lesliie, and LS. Levy, ~. Indoor Environment 2: 143-148, 1993 [See Appendix A]: ~ ~ The authors of this paper compare ASHRAE Stan- ~ dard 62-1989 and a recent Commission of the Euro- ~ pean Communities report that proposed using,per- ~ ceived sensory pollution in determining necessary ~ ventilation rates. They conclude that the ASHRAE ~

14 Standard is a"pragrnatic, sensible and practical" alternative to the use of sensory perception. [43]1 "Status of ASHRAE Standard 62 - Ventilation for Acceptable Indoor Air Quality," W.G. Tucker, Proceedings of Indoor Air `93 3: 525- 530, 1993 [See Appendix A] The chairman of ASHRAE Committee SSPC62, which is reviewing ASHRAE Standard 62-1989, reports in this article on developments in the review process through January 1993. IN EUROPE & AROUND THE WORLD REGULATORY AND LEGISLATIVE MATTERS AUSTRALIA [44] New Advertising Campaign Launched by NSW Health Minister The Health Minister of New South Wales (NSW) has launched an advertisingcampaign! claimingthat nonsmokers can "inhale up to 6 cigarettes a day" by exposure to other people's smoking. The campaign also inchides a fictional brand of cigarettes called "Other People's Smokes", identified as the only brand of tobacco legally available to babies andchildren. The campaign includes a series of television and radio commercials. The Health IVlinisteralso supports a proposal to prohibit smoking in the NSW Parliament. See Tele- graph Mirror and Illnwarra Mercury, October 25, 1993. [I45] Antismoking Group Places ETS Advertisement The Australian government-funded organization Quit has placed an advertisement in the October 115, 1993, Sydney Morning Herald seeking,responses from indi- viduals who are exposed to ETS and purportedly suffer from chronic respiratory conditions. The adverr.isement- states,"ATTENTION: Are you or your children exposed to smoky environments? Do you or your children suffer from persistent coughing, wheezing or ETSlIAQ REPORT„ISSUE 59 asthma? We want to hear fromyou," and gives a phone number. Quit is responsible for promoting nonsmok- ing among Australians. H UN GARY [46] Smoking Ban Proposal Fails to Pass in Budapest A proposal to restrict smoking in public places reportedly failed to pass the assembly of Budapest's local council. Officials apparently decided that such legislation ~ should originate from the mayor's office. The mayor is expected to submit a proposal by Decem- ber 1, 1993'. See Budapest Week, October 7-13, 1993. MALAYSIA [47] More Public Areas to be Designated Nonsmoking Malaysian press reports indicate that the Health Minister has announced that more public places will be designated as nonsmoking areas under smoking restrictions to be imposed in May 1994. Entertainment centres, hospitals, cinemas and public transport vehicles will be affected by the regulations. SecBusiness TimesMalaysia, October 15, 1993. UNITED~ KINGDOM [48] Office of Population and Censuses to Investigate Parental Smoking According to a news report, the Office of Population Censuses and Surveys will investigate the claimed effects of exposure to parental smokingon 3,000 childrenL The children will be asked questions about: ETS and will undergo a saliva test for traces of cotinine. See The Independent, October 18, 1993. LEGAL ISSUES AND DEVELOPMENTS UNITED KINGDOM [49] "The Effect of Implementation of Non-smoking Policies in the Workplace: An Update on the Law," L. Goldman, Addiction, 1993 This editorial! discusses developments in the law in recent years regarding smoking policies and options in workplaces around the world. The author cites the EPA Risk Assessment on ETS and the 1988 European Commission Resolution proposing that member states

NOVEMBER 5, 1993 ban smoking,in public places and workplaces. The tenor of the editorial indicates that the author is disappointed with the sluggish legislative response to such developments. In the absence of government proscriptions, the author suggests that employers institute smoking bans to avoid legal liability. She recommends consultation with employees to avoid a judicial declaration that the employer has instituted an unreasonable changed in working conditions. OTHER DEVELOPMENTS FRANCE [50] Surveys Report French Attitudes About ETS According to a poll carried out in: conjunction with Europe Against Cancer Week last month, approxi- mately 79'percent of the French people responding to the survey think ETS poses a risk to health. See Le Figaro Economique, October 13, 1993. Nevertheless, an unrelated survey carried out by the French CDIT (Centre de documentation cc d'information, sur le tabac)'reports that 71 percent of the French believe that smokers and' nonsmokers should settle their disputes among themselves. See Le Soir, October 29, 1993. UNITED KINGDOM [51] Smokers Fired for Smoking on Factory Roof According to a press report, two smokers were fired for smoking in the open air on the roof of a candy factory: The food factory reportedly has a strict nonsmoking policy, and the employees were "sacked~ for gross miscon- duct." Sce The Daily Mai4 October 26, 1993. 15 MEDIA COVERAGE UNITED KINGDOM [52]I "Bang Goes That Freedom," B. Levin, The Times, October 19, 1993 This article, written~by a nonsmoker, discusses an unidentified incident in the United States in which a smoker was purportedly shot and killed in a Los Angeles restaurant for lighting a cigarette. The author questions government and social' policies that have become extraordinary for their "incivility, ferocity and' mendacity" with respect to smokers. Asking "Is there not in the world enough ~ hatred, poverty, famine, ugliness, incurable disease, misery, crime, deformity and a thousand more afflictions to which we could address ourselves in the hope of ameliorating some of them, that we fasten on this one,, and this one alone?," the author fears that we willlone day be living,in "a kind of cleansed Brave New World, living,in an entirelyartificialiantiseptic atmosphere, with everything that can be touched gleaming from its perpetual washings."

NOVEMBER 5, 1993 APPENDIX A The numbers assigned to the following article summaries correspond~ with~the numbers assigned to the synopses of the articles in the text of this Report. LUNG CANCER [361 "Previous Cancer and Radiotherapy as Risk Factors for Lung Cancer in Lifetime Nonsmok- ers," G.C. Kabat, Cancer Causes and Control4: 489-495, 1993 "Two factors which have received little attention in previous epidemiologic studies are previous primary cancers and history of radiotherapy. The present analysis was undenaken to examine the association of these two variables as risk factors for lung cancer occurring in lifetime nonsmokers." "All subjects were interviewed in the hospitall by trained interviewers who administered'a questionnaire covering: demographics; lifetime smoking history; alcohol intake; occupation and& occupational exposures; and: a detailed history of exposure to environmental'l tobacco smoke." "In females, eight out of 47 cases (1i7 percent) compared with eight out of 132 controls (six percent) reported a! prior primary cancer (crude odds ratio [OR] = 3.2, 95 percent confidence interval [CI] = 1.1-9.0)'. Seven female cases (15 percent) and six controls (five percent) reported having received radiotherapy: crude OR = 3.7 (CI = 1.2-10:9), "Seven, female cases (15 percent),and five controls (four percent) had had a prior primary of a reproduc- tive cancer: OR adjusted for age, years of education, hospital, lifetime environmental tobacco-smoke exposure, and BMI [body mass index] was 4.9 (CI1 1.4-17.7) The OR for, history of radiation therapy adjusted' for the same variables was 4.4 (CI = 1.3-15.1). When history of radiotherapy and previous reproduc- tive primary were entered simultaneously in the model, the ORs were reduced to 2.9 (CI = 0:7-12.7)1 for previous reproductive primary, and to 2.2 (CI = 0.5-9.2) for history of radiotherapy." "The finding in this study of an association of a history of reproductive cancer and a history of radio- therapy with lung cancer in female nonsmokers is of A-1 interest in view of the magnitude of the associations (adjusted ORs for either factor entered separately in the model are in the range of 4.0 to 5.0). In comparison, the average relative risk of lung cancer in nonsmok- ing women with husbands who smoke is 1.34 (CI = 1.118-1.53)." "Radiation treatment and a history of a previous reproductive cancer were correlated so highly among, the cases in these data that it was not possible to examine the effect of one factor independent of the other....The observed interaction between history of radiotherapy and previous reproductive primary suggest that the two variables taken together are better predictors of lung cancer in never-smokers than either alone." "The associations of a history of reproductive cancer and of a history of radiotherapy with subsequent lung cancer in women can be explained in three ways: (i): the second 'primary' is not a: true primary but is due to spread of the reproductive cancer; (ii) radiation treatment for a prior~ condition induced the lung cancers; and (iii) lung cancer in women may share certain nontobacco risk actors (such as reproductive factors) with breast, endometrial. and other reprod'uc- tive eancers." "Limitations of the presentt study include: the smalll number of subjects with a previous primary or a history of radiotherapy; the combining,of cancers of differentt sites; and the lack of an independent review of lung cancer hi'stology. Larger datasets will be required to evaluate the association of specific previous primaries and! history of radiotherapy with subsequent lung cancer in women." [37] "lincidence of Cancer Among Male Waiters and Cooks: Two Norwegian Cohorts," K. Kjaerheim and A. Andersen, Cancer Causes and Conrrol4: 419-426, 1993 "The consumption of alcohol varies in different occupational groups, and occupations of waiter as well as cook have been identified at high risk for high alcohol consumption and' alcoholism. The occupation of waiter has been found to be among those with the highest percentage of daily smokers, and,, additionally, waiters are exposed to passive smoking at work, which also has been associated with in- creased risk of lung cancer."'

A-2 "Because few cohort studies have been performed on cancer incidence in restaurant workers, which are thought to be high risk groups for cancer, we decided'to anaNyie cancer incidence in two historical cohorts of male waiters and cooks." "The present study shows an excess risk of alcohol-associated cancer cases among waiters and cooks alike, and an excess of lung cancer cases among waicerss only. The division of the cohorts into persons living in Oslo and persons living outside Oslo showed very similar results for the two residential subgroups. This indicates that the elevations of the alcohol~ and! tobacco-related cancers in these cohorts are not an exclusively big-city phenomenon, but are linked to the occupational status as suchL" "The main~ results suggest the most important etio- logic factors to be alcohol consumption or tobacco smoking, alone or in combination. It is a limitation of this study that individual information on exposure to alcohol and tobacco is lacking." "Taking,into account the partly different working environments of the two groups, passive smoking also should be considered as a possible explanation of the difference in lung cancer ratio. Research on passive smoking in association with lung,cancer has shown risk ratios ranging between 1.24 and 1.44, but most of this research refers to persons with a much lower level of exposure than waiters. Few, if any„occupational groups are exposed! to passive smoking in the way waiters are. Studies of cotinine in sputum from non-smoking banend'ers have shown median cotinine levels of 7.95 ng/ml, with maximum levels exceeding 3&ng/mli. For purposes of comparison, levels between 1.35 ngL'ml and 2.15 ng/ml have been found im 11- to 16-year-old children when one parent smokes. It also has been shown that an increased level1 of blood cotinine corre- sponds with increased levels of carcinogens in blood." "This study has shown an~excess of cancer cases associated with alcohol! consumptions and tobacco smoking in waiters, and with alcohol consumption in~ cooks. Comparison of the present results with the results of other studies and with our own exposure dataa tend to indicate that alcohol and'tobacco are the main hazards. However,,whether, these results are due to selective forces in the recruitment of persons to the occupations of waiter and' cook, the easy availability of alcohol, coping strategies for stress factors in the work ETS/1AQ REPORT, ISSUE 59 environment, or a cultural phenomenon of drinking and smoking habits in this group, are questions to be discussed in later research." OTHER HEALTH ISSUES (38]I "Complex Mixtures of Tobacco Smoke and the Occupational Environment," D.M. Aviado. In: Patty s Industrial Hygrene and Toxicology (Fourth Edition, Volume 2, Part A). G.D. Clayton and F.E. Clayton (eds.). John Wiley and Sons, 107-148, 1993' "The scientific questionls as follows: Is nonoccupa- tional or household exposure to chemicals relevant to workplace exposure? The question~applies to recent events relating to possible health effects of worker exposure to environmental tobacco smoke (ETS)'." "The potential association of increased! disease risk with ETS exposure to nonsmoking workers is presently being considered by OSHA. According to a Current Intelligence Bulletin released in 1991 by NIOSH, there is an association between~spousallsmoking and increased incidence of certain cardiopulmonary diseases, especially lung,cancer, but possibly heart disease as well. The association was derived from epidemiolbgic studies of nonsmokers who reported exposure from cigarette smoking spouses. So far, there are no reported epidemiologic studies designed to examine the incidence of cardiopulmonary disease ia nonsmoking workers sharing work facilities with~ smoking workers. Only respiratory tract irritation has been reported, but there are no specific studies on occupational heart disease, neoplastic disease, and respiratory tract disease." "Respiratory tract irritation has been reported to be associated with constituents in ETS. Workers in crowded and smoke-filled bars, restaurants, kitchens, and other public places report episodes of mucosal irritation of the nose, mouth, throat, respiratory airways, and conjunctivae. The reported elevated levels of nicotine and other constituents in ETS are less than the respective TLVs, suggesting that any respiratory tract complaints are the summation of subthreshold effects. Any one of a dozen constituents can be used' as

NOVEMBER 5; 1993 a marker for potential irritants in ETS, but the most informative is the specific prototype, that is, nicotine. Nonventilated' chambers have been used to simulate smoke-filled rooms, and the phenomenon of respira- tory tract irritation seen in workplaces has been reported. The irritation is readily reversible by resumption of adequate ventilation to dispose of high levels of ETS." "The potential associations between spousal smoking and the incidence of cardiopulmonary disease cannot be extrapolated to workers. Spousal heart disease, spousal neoplastic disease, and childhood bronchial asthma are cardiopulmonary disease entities with clinical features and pathogenesis different from corresponding occupational diseases. Other than the obvious difference in age (childhood versus adult)'and gender (spousall disease in women versus occupational disease in men), there are compelling differences. Epidemiologic studies relating to household exposure and spousal and childhood diseases consist almost entireiyofquestionnaire responses. If there is personal contact between medical personneliand subject (child or spouse), it usually occurs once for the explicit purpose of obtaining past medical history and estimat- ing ETS exposure, but without actual measurement of ETS levels. There has been no uniformity in question- naires used so that deficiencies of earlier epidemiologic studies are only partially corrected in later ones." "The evolution of occupational disease is an extended process lasting for several years. 1'Vledical~records prior to employment and yearly examinations are necessary to detect the occurrence of cardiopulmonary disease. Diagnostic and research techniques for detection of occupational heart disease have been cataloged, to- gether with relevant experimental animallprocedures to serve as a model for reviewing,whether ETS exposure of workers is associated with any form of heart disease. Because workers not exposed to ETS and workers exposed to ETS in the same occupational group have not been medicaINy fol'lowed for several years, there is no justification to apply the reasoning that because home exposure through spousal, smoking might be associated with cardiopulmonary disease, then work- place ETS exposure can be expected to have a similar association."' "Results of household exposure cannot be applied to workers. The ongoing controversy between work standards proposed by ACGIH and those proposed by A-3 NIOSH is in part the outcome of differences in opin- ion. Only data derived from occupational groups are used! by ACGIH, whereas NIOSH relies on data derived form nonoccupational and family groups. The contro- versy extends to the consideration of occupational diseases purportedly associated with ETS. Confounding factors related to ETS exposure in workplaces are different from factors influencing spouses and children in studies of household exposure. Dietary factors and' household pollution may influence the incidence of spousall and childhood diseases. On the other liand, workers are exposed! to industrial chemicals and outdoor pollutants as well as work-related stress. Familiat patterns of inherited or acquired susceptibility to cardiop- ulmonary disease do not apply to occupational groups." "Uhlike household! exposure, workplace exposure can be monitored by good industrial hygiene practice. There are adequate ETS markers for exposures to certain constituents: carbon monoxide for ischemic heart disease, benzo[a]pyrene for neoplastic diseases, and nicotine for respiratory tract irritation. These markerss can continue to be monitored in a prospective study of workers differentiated according to ETS exposure. Suchh a study will require considerable expense and human effort. A simple recourse is to regard ETS as a complex mixture, similar to vehicular emission. As long as carbon monoxide is not allowed to accumulate in workplaces by adequate ventilation, ETS is unlikely to be associatedl with reports of respiratory tract irritation. ETS levels that are sufficiently high to provoke complaints of irritation can serve as an indication that corrective measures should be initiate& to increase workplace ventilation." [39] "Nicotine Exposure and the Risk of SIDS," J. Milerad and H. Sundell, Acra Paadiatrica (SuppL)389: 70-72, 1993 "Several epidemiological studies indicate that smoking during pregnancy and nursing is a major and indepen- dent risk factor for sudd'en infant death syndrome (SIDS)." "Parental smoking also increases morbidity in lower respiratory tract infections, which is another factor associated'with SIDS. However, the increased risk remains after correction for socioeconomic factors. The secondary effects of passive smoking,are thus not sufficient to explain the increased risk." 2024702627

A-4 "Passive smoking and breast milk transfer have both been shown to produce significant levels of cotinine in urine and plasma in exposed infants. While victims of SIDS have been exposed: to passive smoking more often, it is not clear if there is a relationship between nicotine exposure and death." "We have investigated if exposure coincides with the time of death by analyzing the levels of nicotine and cotinine in the pericardial' fluid in 24 consecutive deaths in children under the age of one year. As is typical of the clinical history of SIDS, the infants had d'ied'suddenly without known previous disease. Sixteen cases had no positive findings at autopsy, while con- tributing factors were found in eight infants. We foundd that almost half of our cases had' been exposed to nicotine (cotinine levels 5-50 ng) and one-third heavily exposediaround the time of death (cotinine > 50 ng)." "Therefore, death from~ SIDS seems to coincide more often with nicotine exposure than what could be expected from smoking habits in the generallpopulation."' "The effects of parental smoking and nicotine exposure link a number of seemingly independent observations in SIDS research. There is accumulating evidence that fetal development and wellbeing are closely related to the subsequent risk of SIDS in the offspring. Furthermore, it appe'ars that this risk is related, in particular, to alterations in braMdevelop- ment. The risk of dying of SIDS may thus, in reality, be confined'to a limited number of infants wizh~ develbpmental changes in CNS functiom Our findings of age-specific attenuation of hypoxic defense following nicotine exposure focus the attention on brain cat- echolamine metabolism as a potential target for adverse fetal and neonatal influences. To clarify the mecha- nisms of nicotine exposure on postnatal development of the controliof respiration and cardiovascular control may thus offer insights into the ultimate mechanism of SIDS." ETS/IAQ REPORT, ISSUE 59 ETS EXPOSURE AND MONITORING [40] "Relevance of Nicotine Content of Common Vegetables to the Identification of Passive Tobacco Smokers," E.F. Domino, E. Hornbach, and' T. Demana, Medical Science Research 21: 571-572, 1993 "It is a common experience when studying the bloo& and urine levels of nicotine andits metabolites in tobacco smokers compared with nonsmokers to find! that many of the latter have small but detectable levels of nicotine and its metabolites.... The presence of nicotine and cotinine in body fluids of nonsmokers is usually taken as evidence of passive smoking exposure. This is because nicotine when~ present in air is allmost always due to contamination by tobacco smoke." "Very recently, the Center['s] for Disease Control and Prevention completed a study of 800 people, both smokers and nonsmokers, who all tested positive for cotinine. It has been our experience that some non- smokers in whom small amounts of nicotine and cotinine were present insist that they had absolutely no contact with tobacco smoke and smokers for extended periods of time sufficient that nicotine and its metabo- lites should have been excreted."' "Even when precise nicotine-fee analytical techniques are used to insure that no nicotine contamination has occurred, some body flliid's of nonsmokers not exposed to environmental tobacco smoke stiRcontain small amounts of nicotine and cotinine. Dietary sources of nicotine in common foods could be responsible for the nicotine and cotinine concentrations in the body fluids of some nonsmokers."' "There has been considerable evidence over the years that nicotine is present in certain foods, especially plants from the family Solanaceae." "The purpose of the present research was to confirmm these reports in our own laboratory...as the basis of a future possible human study on the actual ingestion of nicotine containing foods in nonsmokers." "If one assumes complete absorption of nicotine from the lungs, then it would take about 142-238 min of breathing air from a minimal smoke environment or the ingestion of about 140 g of cooked potatoes to achieve equal body exposure to nicotinc assuming 100% oral nicotine bioavailabiliry."

NOVEMBER 5, 1993 "One pound of potatoes is approximately 455 g or about 2 medium sized potatoes. The nonsmoker would need to be in a low concentration smoky room for 455C1!40 X 143 to 238 = 465 to 774 min to obtain the equivalent amount of nicotine to eating about one pound of medium sized potatoes available from one particular supermarket in Ann Arbor, MI." "Three additional points should be made regarding nicotine exposure and its urinary metabolites." "(1'1) Nicotine biotransformation in humans is highly variable." "(2) Nicotine in environmental tobacco smoke is in a, vapour phase that readily adheres to many sur- faces. One may be exposed'to nicotine as it desorbs from such surfaces." "(3) The US EnvironmentaliProtection Agency has assumed that control groups in, epidemiologic studies are exposed to environmental tobacco smoke based on the presence of cotinine in the control group's urine. As a result, the Environ- mental Protection Agency uses a background correction that raises the risk estimate from, 1.19 to 1.59. Obviously, low levels of cotinine in urine can occur from other sources than tobacco smoking, making a background correction erroneous. The above issues have been discussed previously by others but need to be re-emphasized." "It appears that the dietary intake of nicotine in nonsmokers is of practical! importance in the interpretation of passive smoke inhalation by nonsmokers when determining blood and urinary nicotine and cotinine levels. Further research correlating the amount of vegetable intake with urine levels of nicotine and its metabolites is necessary and should be pursued." INDOOR AIR QUALITY [41] "Is It Time to Change the Terminology of Sick Building Syndrome?" B. Jarvholm, Indoor Environment 2: 18G-188, 1993 "'Sick Building Syndrome' (SBS) is a common term in indoor environment literature.... Over the years, SBS has been used to describe many symptoms which are believed to be caused by some factor(s) in buildings.... The custom of using SBS for a broad A-5 range of symptoms, usually of unknown origin, has made the term less useful. I's it time to abandon SBS and use a new and more distinct terminology?" "There are several reasons why the use of the term SBS should be avoided."' "(1) SBS is vaguely defined. It consists usually of some symptoms related~to a nonindustrial workplace. However, it is unclear how many of the symptoms should occur and if they are and how they should! be associated with the building. Some authors obviously use the term without the knowledge of whether or not the symptoms are causally linked to the building, e.g:, its walls, floors or ventilation system." "(2) The term SBS suggests that there is knowledge that the symptoms actually are causedby factors in the building, while the term usually is used in situations where such knowledge is missing." "(3) It is sometimes claimed that SBS is a multifacto- rial disease. Such information is of little value, as most or all diseases have multifactorial causes." "(4) Medical diagnoses and syndromes are usually based on pathological changes in certain organs ... in other cases, they are basedion etiological factors...SBS does not satisfy any of these criteria." "(5): It is now at least 10 years since SBS was defined by a WHO working group. The term has obvi' ously not improved the understanding of the occurrence of these symptoms." "If it can be shown that the illness is caused by some factor(s) related to the ventilation systems it must be much better to report that, for example, 'there is an increased prevalence of mucous membrane irritation and lethargy due to malfunction of the ventilation system' than to say that 'there is a SBS'. Thus, it is suggested that the medical problem should be described in ordinary terms." [42] "New Approaches for the Determination of Ventilation Rates: The Role of Sensory Percep- tion," M.V: Jiokl, G.B. Leslie, and' LS. Levy, Indoor Environment 2: 143-148, 1993 "The Commission of the European Communities recently issued a report proposing 'Guidelines for Ventila- tion Requirements in Buildings'. This report makes recommendations on appropriate ventilating rates for buildings in order both to minimize any health risk for

A-6 building occupants and' to ensure that the air is perceived as fresh and comfortable by the occupants." "The guidelines suggest that perceivedisensory pollution can be used to determine necessary ventila- tion ~ rates during the design stage of a building."' "An existing alternative to the guidelines proposed in the EEC report is the American Society of H'earing, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 62-1989." "This paper compares the ASHRAE approach with that suggested by the EEC. More specifically; it assesses the use of decipol/'olf values as the parameters for defining ventilation rates in European buildings:" "Because of the diversity of the sources and types of indoor air pollutants, many have advocated that the best way in wlii& to ensure good' indoor air quality is to provide sufficient ventilation. In this manner the accumulation of indoor air pollutants can be avoided by adequate replacement of stale air by fresh air. This approach can provide comfort and protect health." "The most recent guideline from ASHRAE on indoor air quality management is a standard broadly based on the provision of sufficient ventilation." "The EEC guidelines also aim to ensure adequate indoor air quality from the standpoint of both health and comfort for the occupants." "The guidelines suggest that, in practice, comfort rather than health defines the required ventilation. The comfort criteria depend on the use of the olf concept. Because typically odour is sensed before irritation or other subjective sensory reaction,,this in reality be- comes an~ od'our standard." "One olf unit is defined as the pollution emitted by one standard person, that being an average sedentary adult office worker feeling,comfortable with the ambient temperature and with a hygienic standard equivalent to 0.7 baths per day." "On initial consideration it may seem that the concept of using sensory perception as the determinant of air quality is a helpfull and sensible approach. However, the manner in which this is applied to the EEC guidelines for setting ventilation rates for air-conditioned buildings seems premature and has practical difficulties. For one, it leaves far too mu& to ETSIIAQ REPORT, ISSUE 59 guesswork. Many of the parameters necessary to use this approach are not known, or at least are not defined fully. Even if there were a larger database on the sensory pollution loads associated with buildings, odour is not necessarily the proper marker for maintaining the health of the building occupants and may, in some circum- stances, underestimate the risks to health. The EEC report does have a provision to estimate ventilation rates based on health considerations, but again far too few of the parameters involved in this estimation are known to allow an architect to design a building based on these guidelines. To assist in this, the WHO Air Quality Guidelines for Europe are summarised in an appendix,, but are not really incorporated into the ventilation guidelines for the European Community." "A far more practical approach is given in the ASHRAE Standard 62-1989. Here minimum ventila- tion rates for various environments are defined, so that the designer has a specific and fixed target to achieve. This standard has been in~operation in the United States for a number of years, and used in many other coun- tries. It seems to work well. Clearly, it has its faults but it is simple, practical and relies little on assumptions which may or may not be the prime determinants of both comfort and health risk. Whether precisely this standardis the best one for the European Community is open to debate, but the generallconcept employed by ASHRAE at least points in a direction which can be achievedl Sensory perception of occupants is, of course, an important consideration in ventilation design, but the way in which it is incorporated into guidelines for ventilation calculations seems to have little relevance to health." [43] "Status of ASH RAE Standard 62 -- Ventilation for Acceptable Indoor Air Quality," W.G. Tucker, Proceedings of Indoor Air 93 3:. 525-530, 1993 "This paper briefly describes the purpose, history, and major features of American Society of Heating, Refriger- ating, and Air-conditioning Engineers (ASHRAE). Standard 62. The primary focus of the paper is on the status of the review and revision process as of January 1993. The current working outline of the revised standard is presented and discussed. The complemen- tary roles of ventilationj source management, and air cleaning are emphasized. Extending the standard beyond ventilation system design to include operation

NOVEMBER 5, 1993 and maintenance of buildings and ventilation systems is also projected," "As part of ASHRAE's policy to review standards every 5 years, a new committee was formed' in January 1992 to review Standard 62-1989, and to develop revisions as needed. The committee consists of 25 designers, equip- ment manufacturers, regulators, and researchers." "Special emphasis is being,placed on reviewing the scientific information that can be used as the basis for the health and sensory comfort guidance that the document uses to define acceptable indoor air quality. Another special emphasis is on making dearer links between sources of contaminants and control of indoor air qualiry by ventilation, source management, or air cleaning. Progress in these two areas is key to improving the soundness and usefulness of the two design ~ procedures." "The current review is focused on issues that have been raised over the past several years in various technical meetings and in feedback to ASHRAE from the design community. It is unreasonable to expect ventilation, which acts primarily by dilution and displacement of indoor contaminants, to provide acceptable indoor air quality by itself. Special emphasis is therefore being given to the health and comfort basis of the standard and to describing the complementary roles of source control and air cleaning for providing good indoor air quality. The review committee is also committed to simplifying and darifying the standard where possible, in~ response to requests from design engineers and building code officials." "The primary changes frorn~Standard 62-1989 that are currently being considered are to provide separate sections for residential buildings and design documentation; new material on operations and maintenance and design calculations; more explicit treatment of source manage- ment and air cleaning as options to ventilation for ensuring acceptable indoor air quality, and! darifications or modifications to the Ventilation Rate and Indoor Air Quality Procedures. It is also the revision committee's intention to use 'code language' to make Standard 62 easier to adopcby governmentaL bodies that establish legal specifications (codes) regarding design and operation of buildings and their HVAC systems. An alterative may be to prepare a specification version for code officials, and a more extensive version with guidance for designers and building owners and operators." A-7 "Other ventilation standards and guidelines are being reviewed' for ideas on how Standard' 62 should be structured. Uhder the European ventilation guidelines, three design levels are offered for perceived indoor air quality (which is similar to sensory comfort, as used in this paper)'. Ventilation rates arc calculated separately for health and perceived air quality; the higher rate is recommendedfor design. These and other approaches will be considered by the SSPC62 committee."'

NOVEMBER' 5, 1993 B-1 APPENDIX B UPCOMING SCIENTIFIC MEETINGS • Novernber 7-10, 1993 Ind'oor Air Qualiry '93: Operating and Main- taining Buildings for Health, Comfort and Productivity, ASHRAE, Philadelphia, Pennsylva- nia [Issue 49, Item 34] November 11-13, 1993 Contemporary Concepts of Indoor Air Qualiry; Hacettepe University, Ankara, Turkey [Issue 49, Item 36]I November 16-17, 1993 Bugs, Mold & Rot I!I: Control of Humidity for Health, Artifacts and Buildings, Building Environr ment and~ Thermall Envelope Council, Alexandria, Virginia [In This Issue] • December 15, 1993 Iind'oor Air Quality: An Overview for People Who Need'to Know, AIHHM, SanAntonio, Texas [,Issue 57, Item 35] Same program to be held March 4, 1994, Orlando, Florida; April 113, 1994, Minneapolis, Minnesota; May 5, 1994, Chicago, Illinois; June 17, 1994, Oklahoma City, Oklahoma; July 14, 1994, Anchorage, Alaska « December 16-17, 1993 The National Environmental Tobacco Smoke Conference: Public Battles, Private Choices, IAQ Publications, Washington, D.C. [Issue 55, Item 34] • March 28-31, 1994 Eleventh ORNL Life Sciences Symposium, Indoor Air and Human Health Revisited (Bringing Se- lected Advances in Medical! Science to the Indoor Air Quality Community), Knoxville, Tennessee [Issue 58, Item 43] • May 5-7, 1994 Second Annual IAQ Conference and' Exposition, NCIAQ Tampa, Florida [Issue 49, Item 35] • May 22, 1994 Indoor Air Quality Symposium, American~ Indus- trial Hygiene Conference and Exposition, Anaheim, California [Issue 57, Item 3'4] • October 18-20, 1994 Indoor Air Quality in Asia, Beijing, China [Issue 54, Item 42]I • October 30-November 2, 1994 IAQ'94: Engineering Indoor Environments,. ASHRAE and other sponsors, St. Louis, Missouri [Issue 58, Item 421

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